Table 3 Clinical information of patients presenting with rapidly decline renal function/AKI
From: Managing acute presentations of atheromatous renal artery stenosis
Presentation | Co-morbidities | Clinical Features | Anatomy | Intervention | Outcome | |
|---|---|---|---|---|---|---|
1 | 56 yr female referred from another unit with AKI, volume overload and htn | Diastolic dysfunction HTN ( 4 agents) PVD with claudication distance of < 20 m CKD (eGFR 29 ml/min) Smoker | BP: 189/90 mmHg Creatinine: 1017 µmol/L (AKI on CKD) with hyperkalaemia and metabolic acidosis | MRA Rt: 100% (8.5 cm) L: > 80% (10.5 cm) | LPTRAS | Immediate ↑ in UO (1.5L/24 h) and ↓ creatinine to 598 µmol/L 1 month: Creat 115 µmol(eGFR: 44 ml/min) BP: 149/70 mmHg on 2 agents RIP 7 years later: no further presentations |
4 | 78 yr female transferred from another institution to our unit with accelerated phase hypertension, deteriorating renal function and pulmonary oedema | HTN with LVH NIDDM CKD (eGFR 40 ml/min) History of temporal arteritis PVD Diverticular disease Renal adenocarcinoma requiring L nephrectomy | Bp: 157/80 mmHg on iv diuretic infusion and 4 agents Volume overloaded Creatinine: 519 µmol/l (eGFR: 7 ml/min) | MRA Rt: > 90% (11 cm) | Rt PTRA | Within 1 week: BP < 130/80 mmHg on 2 agents Independent of RRT with creatinine of 128 µmol/L |
5 | 63 yr male transferred for AKI on CKD | CKD 3 (ARVD within previous L PTRAS in 2012) HTN Previous ischaemic stroke NIDDM Hyperthyroidism treated with radioactive iodine therapy Smoker | BP: 198/92 mmHg on 3 agents Creatinine: 319 µmol/L(eGFR: 9 ml/min) uPCR: 800 mg/mol | Formal Angiogram: Occluded L stent | L PTRAS (Fig. 2) | Within 1 month: BP: < 130/80 mmHg on no agents Creatinine:240 µmol/L (eGFR: 24 ml/min) uPCR: 132 mg/mol |
9 | 74 yr female presented acutely with anuric AKI | HTN IHD with angina Macular degeneration Smoker | BP 190/90 mmHg Volume overloaded Creatinine: 633 µmol/L (eGFR: 6 ml/min) | Renal US: Rt: 11 cm L: 8.2 cm Formal Angiogram: Rt: > 70% L: 100% | Rt PTRAS | Within 1 month: BP: < 130/80 mmHg on single agent Creatinine: 150 µmol/L (eGFR: 31 ml/min) |